[Early postoperative hyperlactatemia in patients after surgery under extracorporeal circulation].

Metabolic disturbances, such as changes in blood acid-base balance and electrolytic composition; hyperglycemia and hyperlactatemia, are frequent factors that complicate the early postoperative period in patients after cardiac surgery under extracorporeal circulation. The purpose of the study was to estimate the incidence of hyperlactatemia in the early postoperative period and to reveal the predictors of its occurrence. This prospective study was conducted in our center from November 14, 2006, to September 1, 2007. The study covered 270 patients above 15 years of age, who had been operated on for coronary heart disease, acquired heart diseases, and combined lesions of valves and coronary arteries. Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation. Correlation analysis indicated a significant association between the duration of extracorporeal circulation and the magnitude of hyperlactatemia developing in the early postoperative period. Hyperglycemia with a glucose level of > 9 mmol/l is a predictor of the development of hyperglycemia.

[Clinical experience with voluven solution used as a basic component for pump oxygenator filling during operations on the cardiac valves and coronary arteries].

The present study comparatively analyzed the clinical effects of three solutions used to fill an extracorporeal circulatory circuit (ECCC). The arterial and venous blood samples taken from patients operated on for valvular disease and coronary heart disease were studied. All patients (n = 61) were divided into 3 groups according to the basic component of the primary volume of ECCC filling: 1) Ringer's crystalloid solution; 2) gelofusin; 3) the hydroxyethyl starch 130/0.4 Voluven. The resultant samples were examined for the following parameters: a) hematological: the levels of formed blood elements, hemoglobin, erythrocytic hemoglobin, and free hemoglobin and the histograms of leukocytes, erythrocytes, and platelets; b) physicochemical: arterial and venous blood pH, pO2, pCO2, SatO2; c) biochemical: blood electrolytic balance and lactate levels. The values of hemoglobin, hematocrit, and blood gas composition were used to calculate oxygen consumption (ml/min x m2). The parameters of central hemodynamics and the temperatures in the rectum, esophagus, and venous oxygenator port were continuously monitored during extracorporeal circulation (EC). At its end, overall diuresis and water balance were determined. The plasma-substituting effect of Voluven was found to be highly effective during a clinical study. The found beneficial properties of the agent may be particularly attractive while applying EC to the surgery of acquired heat diseases when the duration of an operation and, accordingly, extracorporeal support forces the physician to administer large solution doses many times.